Hidden in Plain Sight: Domestic Violence and Brain Injury

Rachel Ramirez, Director of Health and Disability Programs, Ohio Domestic Violence Network

It’s football season, and there is no doubt concussions will become a topic of discussion again. The 2022 National Football League (NFL) season brought changes to the NFL Concussion Protocol after several very public and very disturbing concussions witnessed by millions. While coalitions such as Concussion Awareness Now (the CAN Coalition, led by the Brain Injury Association of America) are working to educate the public on the multiple causes of concussion, to most average people, concussion is very much associated with sports. Yet there is another invisible group left out of this discussion—domestic violence victims, who suffer violent attacks to the head, neck, and face at alarming rates. These concussions and brain injuries go unrecognized and untreated, exacting devastating consequences on a person’s health and impacting their daily life.

As a domestic violence professional with almost two decades worth of experience, it wasn’t until seven years ago that it crossed my mind that domestic violence could cause brain injuries. We received a grant to address this issue and did research with The Ohio State University that discovered over 8 in 10 domestic violence survivors accessing services in Ohio experienced blows to the head, neck, and face, and strangulation—a particularly terrifying and brutal cause of brain injuries among domestic violence victims. Their partners hurt them repeatedly, almost none of them received medical care, and most victims were largely unaware of the physical, behavioral, emotional, and cognitive impact brain injury was having on their lives. And it wasn’t just survivors of violence. Professionals and systems working with domestic violence victims had not considered how brain injury affects survivors seeking help, and how they needed to provide services differently.

We set out to change that reality in Ohio. We developed a brain injury-aware, trauma-informed approach called CARE (Connect, Acknowledge, Respond, Evaluate) with guidance for service providers on addressing brain injury caused by domestic violence. In 2019, we created the Center on Partner-Inflicted Brain Injury to provide national leadership on this issue through training, technical assistance, consultation, resources, and support for organizations and systems to better address this issue. Since then, we have provided support to groups in more than 30 states and three countries, and trained more than 20,000 people.

Domestic violence survivors need the services and support of brain injury professionals like you to help them heal and recover from their abusive experiences. And chances are very high that you are working with victims of abuse, even if you are unaware. Providing education and information about domestic violence to all your patients can help survivors gain access to lifesaving resources. You can ask direct questions about head injuries using guidance from the CARE Tool CHATS. Normalizing conversations about relationships and their challenges can help domestic violence survivors trust and share with you. To prepare yourself for these conversations, you must learn about the dynamics of domestic violence and coercive control and the psychological trauma domestic violence causes. You must recognize the significant safety concerns related to abuse, as well as the many difficult barriers to care that deserve consideration, including concerns related to the social determinants of health like systemic oppression, housing stability, employment, childcare, and access to medical care.

Your community has a local domestic violence program that can help you support survivors of abuse. Reaching out to them, learning about their services, and discovering opportunities for partnerships and collaborations is key. The brain injury system can’t do this alone. Neither can domestic violence. It takes all of us.